“Maybe That Will Clean Up”

A slow night, featuring a long winter’s nap, was interrupted by one of our dispatchers sending us on an actual ambulance call. I sprang from my bed and went out to the ambulance to see what was the matter. I didn’t tear open any shutters, but I did tap the computer screen to see what the Fiction Writers Association of America call taker had written in the comments section of the response data.

“Language barrier. Elderly male complaining of chest pain.”

Even though they have a translator service available I’m always a bit skeptical because even when everyone speaks English the Fiction Writers Association of America call takers get it right less than half the time. In fact, I’m delighted when they get the address correct. Which they didn’t in this case.

After what seemed like an hour, but was much, much, shorter, we got the address correction. Interestingly, the two streets, while about 1/2 mile apart only shared one letter in their disparate names.

Hopefully, this call would go better from here on in. As in the rest of the information would be wrong as well and it would be a 20 something female with a headache.

No such luck. It was an elderly male with chest pain. And not a word of English. His wife/daughter/something spoke enough English to tell us that she didn’t speak English.

Swell.

My partner speaks some Spanish, just not as much as he thinks he does. I know a little bit, usually enough to get by, but definitely not great. In fact I refer to it as Pidgin Spanish and it requires many gestures in addition to the words, but it works.

As best as we could figure out he had the pain was dull, radiated to both arms, had awoken him from sleep. From looking at him, he didn’t look that uncomfortable, but old men are very often stoic when faced with pain. His vital signs didn’t shout “HEY STUPID! HE’S SICK, IT’S TIME TO EARN YOUR PRINCELY PARAMEDIC SALARY!”. That left us to put the monitor on and see if the electrocardiograph was going to be at all enlightening.

Enlightening? Yes. Encouraging? Not at all.

“Maybe that will clean up when we do the 12 Lead.”, my partner said optimistically. He’s a regular Pollyanna, that guy. He’s said that about a dozen times over the years we’ve worked together. The bad part is that he’s never been correct.

“Doubt it.” I’m not the optimist he is. He proceeded to put the chest leads on. The sucky low bid chest leads that refused to stick to the patient’s chest. Well V1 and V2 refused to stick.

12 Lead 1 was crappy, so we redid the 12 Lead with me holding V1 and V2 in place.

Not so much in the cleaning up department.

I shook out 4 81mg Baby Aspirin and indicated to the patient that he should chew them up. Which he sort of did. We decided that an IV was in order, but Nitroglycerin probably not given his only OK blood pressure. In the mean time my partner decided that this might be a good time to call the nearest catheter lab equipped hospital and give them a heads up. Appropriately enough, I refer to this as telling them the equivalent of “Air raid Pearl Harbor. This is no drill.” Given the date and all.

We thought we’d try another 12 Lead to see if we could get a better tracing with new electrodes.

Never mind. Not that it really matters, we had enough already to make our diagnosis. Which is Inferior Wall MI with Lateral involvement. From the size of the ST elevations, it sure seemed like a big one. Only one thing to do, now. Well, that’s not true, there were several things to do, including another 12 Lead looking at the Right Ventricle.

It just keeps getting better and better, doesn’t it?

So, we decided that it was time to break out the Fentanyl and give some. The IV was in place, the patient was awake and had a good enough blood pressure and other vital signs and now he was starting to look very uncomfortable.

The ride to the hospital was uneventful. I like uneventful, there is less to write about it.

At the hospital we were met by the reception committee from the cath lab. They directed us to one of the treatment rooms and I innocently asked, “Why don’t we go right to the cath lab?”. They liked that idea so much that they did it and invited us to come along.

Cool.

We stood in the control both, which has more computers and cameras than did NASA Mission Control for the Apollo program. I don’t know why, but it struck me that there was more computing power in that room than existed in the entire country in 1969. But I digress.

We watched as the doctors placed the catheter and then injected the dye. We watched as the Right Coronary Artery showed up as 100% occluded. We even watched as they put a tiny suction catheter into the Right Coronary Artery and sucked out the clot and then placed a stent. We even got to watch the reperfusion dysrhythmias started to rear their ugly heads and the doctors decided whether to watch them or shock them. They decided to watch them and shortly they went away.

The most amazing part is that from the time we first laid eyes on the patient until the clot was sucked out was 48 minutes.

Comments

I always love when the cardiology team just wants us to put the patient into an ED bed… when nothing is done but hook them up to a different portable monitor and then wheel them up to the Cath Lab. Our STEMI triage system is set up to allow us direct transport from the Dock/ED enterance to the Cath Lab. It really annoys me when there is no reason to stop in the ED (such as the Cath Lab ready and waiting and a stable patient), but yet we waste time doing so.

As you can see from looking at the strips it was after 7:00AM, so the cath lab team was already in and setting up for their first scheduled procedures of the day. My partner figured, correctly, that calling early would allow them to preempt someone from a scheduled cath and have the table ready. The crews that work days on a regular basis go directly to the cath labs a lot, but for we night spiders, the cath lab team has to be called in from home and we’re usually at the ED for a bit before they show up. I’ve more often gone directly to the OR with trauma patients because there is a trauma surgeon in house all the time. Maybe some day cath labs will do that as well.

Neither did I, it was pretty impressive. I also didn’t know that they did more caths via the radial artery than the femoral these days. They couldn’t in his case because even with Fentanyl on board they couldn’t get him to relax his arms enough. Still, that’s incredible, at least to me.

All About Me

After a long career as a field EMS provider, I'm now doing all that back office stuff I used to laugh at. Life is full of ironies, isn't it?
I still live in the Northeast corner of the United States, although I hope to change that to another part of the country more in tune with my values and beliefs.
I still write about EMS, but I'm adding more and more non EMS subject matter.
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